economic viability of_autologous_breast_reconstruction_final
TRANSCRIPT
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Pouria MoradiAlexander Hills
Duncan Atherton Simon Wood
Charing Cross Hospital, London
ASC, Perth 2010
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Aims
• Assess the financial implications of breast reconstruction
• Establish whether the current gold standard of DIEP is economically viable
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Materials and methods• Retrospective audit of:
– Procedure – Length of stay– Reconstructive amendments/corrections– Cost
• For 1 surgeon, at 1 unit, between 2000-07
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• Review of surgical diaries cross referenced against electronic patient records
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Results• 274 patients• Average age 48 years
• 278 primary breast reconstructions• 366 secondary procedures• Minimum of 1 year follow up• Mean 3 year follow up
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Breast reconstruction type vs Length of stay (days)
Cost per Median LOS £1,183 £2,475 £2,888 £ 2,200
Median
Mean
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Total number of secondary procedures conducted
Implant
Symmetrisation
Wound care
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Total number of secondary procedures conducted
Implant
Symmetrisation
Wound care
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What are the financial implications of the additional procedures?
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What is the actual cost? THEATRE TIME
• Half day list £3200 » Anaesthetic consultant» ODP Nurse (Band 6)» Theatre nurses (Band 6)» Theatre nurse HCA (Band 2)» Recovery Nurse (Band 6)» A&C Support» Limited non pay consumables
• So a DIEP/TRAM on a full list - £6400• LD and implant - £3200• Implant reconstruction - £1700
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What other costs?
• In patient stay (£275 per night)• DIEP/TRAM - 19 hours of one to one nursing -
£253 (vs £600 for ITU)• OPD attendances (New £152, FU £78)• (Mastectomy)• LD/Implants - Prosthesis – (£250 – £700)
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Tariff Disparity
• Paid solely for the principle procedure
• Separately the mastectomy tariff is £2623 and axillary surgery £2549 (Total £5172)– In 2009-10 with HRG4 coding it will vary from £5132-7015– As not coded - no research grant for masectomy (£480)
• Immediate reconstruction financially discouraged
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Conclusions
• Our belief that autologous reconstruction offers better symmetry at 4-5 years
• Weight change impact on symmetry greater with implants
• Minimal number of procedures– Autologous less secondary procedures than
Implants– Socio-economic costs related to repeat operations
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Conclusions
• Tariff system does not encourage immediate or bilateral reconstruction